1351
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Yedavalli VS, Shah P. Residents' Perceptions of Usage of the Current Alumni and Attending Network for a Formal Mentorship Program in an Academic Affiliated Community Hospital Radiology Residency. Curr Probl Diagn Radiol 2018; 48:105-107. [PMID: 29475569 DOI: 10.1067/j.cpradiol.2018.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/19/2018] [Indexed: 11/22/2022]
Abstract
Mentor-mentee relationships within radiology residencies can add significant value to a resident's overall experience. Studies demonstrate that mentorship programs can increase satisfaction for residents and faculty alike by reducing stress, easing career related decisions, increasing involvement with research, improving teaching and communication skills, and finally increasing leadership roles. In a survey of radiology program directors, 85% of program directors find such a program beneficial but only 57% have a formal program in place. Totally, 42% of program directors believe a structured mentorship program is necessary. Studies have also shown that female residents prefer female mentors. Alumni serve as an ideal group for resident mentorship as they do not face the pressures of internal faculty. No study to date in diagnostic radiology literature uses an alumni network in establishing a formal mentorship program. The objective of this study is to implement a formal mentorship program within an academic affiliated radiology residency by using program alumni and internal attending physicians for potentially increasing faculty engagement, improving resident morale, research opportunities, and networking for fellowship and job opportunities.
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Affiliation(s)
| | - Parinda Shah
- Advocate Illinois Masonic Medical Center, Chicago, IL; Department of Radiology, Advocate Illinois Masonic Medical Center, Chicago, IL
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1352
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Sanfilippo F, Burns KH, Borowitz MJ, Jackson JB, Hruban RH. The Johns Hopkins Department of Pathology Novel Organizational Model: A 25-Year-Old Ongoing Experiment. Acad Pathol 2018; 5:2374289518811145. [PMID: 30456297 PMCID: PMC6238201 DOI: 10.1177/2374289518811145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/27/2018] [Accepted: 09/24/2018] [Indexed: 11/30/2022] Open
Abstract
In 1993, the present Department of Pathology at Johns Hopkins was established with the leadership of a new chair (ie, referred to as department director at Hopkins) and upon the integration of 3 separate and independent departments at the Johns Hopkins School of Medicine (Pathology) and the Johns Hopkins Hospital (Pathology, Laboratory Medicine). This new department was organized into 17 divisions, each of which was expected to develop and maintain significant clinical, educational, and research programs of excellence. To facilitate performance and alignment across missions and parent organizations, a novel professional and administrative structure was created. Professionally, vice-chairs (ie, deputy directors) for research, teaching, and patient care were appointed to oversee and coordinate these activities across all units of the department. Likewise, to focus and enhance expertise, individual administrators were appointed for academic, clinical, and business affairs. A departmental executive committee was created consisting of the vice-chairs and administrators, which was presided over by the chair. Simultaneously, substantial effort was put into measuring and improving the organizational culture using evidence-based methods. Significant improvements were documented by the year 2000 in departmental performance in research, education, clinical service, culture, and finances. Under 2 successive leaders, the department has maintained its eminence across missions and financial performance. This 25-year experience supports the tenet that innovative and strategic organizational structures and functional alignments can provide sustainable competitive advantages in performance.
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Affiliation(s)
- Fred Sanfilippo
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Kathleen H. Burns
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J. Borowitz
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J. Brooks Jackson
- Department of Pathology, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Ralph H. Hruban
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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1353
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Wright JR. When Pathology and Laboratory Medicine Becomes a Commodity and Health Care Becomes Both Its Customer and Owner. Acad Pathol 2018; 5:2374289518785373. [PMID: 30083594 PMCID: PMC6073830 DOI: 10.1177/2374289518785373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/03/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- James R. Wright
- Department of Pathology & Laboratory Medicine, University of Calgary, Cumming School of Medicine, Calgary Laboratory Services—Alberta Children’s Hospital Site, Calgary, Alberta, Canada
- Department of Paediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- Dr. Wright is currently Scholar-in-Residence, The Ohio State University Medical Heritage Center, Columbus, OH, USA
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1354
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Sanfilippo F, Powell D, Folberg R, Tykocinski M. Dealing With Deans and Academic Medical Center Leadership: Advice From Leaders. Acad Pathol 2018; 5:2374289518765462. [PMID: 29662949 PMCID: PMC5894898 DOI: 10.1177/2374289518765462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/11/2018] [Indexed: 11/18/2022] Open
Abstract
The 2017 Association of Pathology Chairs Annual Meeting included a session for department chairs and other department leaders on "how to deal with deans and academic medical center leadership." The session was focused on discussing ways to foster positive relationships with university, medical school, and health system leaders, and productively address issues and opportunities with them. Presentations and a panel discussion were provided by 4 former pathology chairs who subsequently have served as medical deans and in other leadership positions including university provost, medical center CEO, and health system board chair. There was a strong consensus among the participants on how best to deal with superiors about problems, conflicts, and requests for additional resources and authority. The importance of teamwork and accountability in developing a constructive and collaborative relationship with leaders and peers was discussed in detail. Effectiveness in communication, negotiation, and departmental advocacy were highlighted as important skills. As limited resources and increased regulations have become growing problems for universities and health systems, internal stress and competition have increased. In this rapidly changing environment, advice on how chairs can interact most productively with institutional leaders is becoming increasingly important.
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Affiliation(s)
- Fred Sanfilippo
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Deborah Powell
- Department of Pathology and Laboratory Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Robert Folberg
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Mark Tykocinski
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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1355
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Conran RM, Powell SZE, Domen RE, McCloskey CB, Brissette MD, Cohen DA, Dixon LR, George MR, Gratzinger DA, Post MD, Roberts CA, Rojiani AM, Timmons CF, Johnson K, Hoffman RD. Development of Professionalism in Graduate Medical Education: A Case-Based Educational Approach From the College of American Pathologists' Graduate Medical Education Committee. Acad Pathol 2018; 5:2374289518773493. [PMID: 30014035 PMCID: PMC6039899 DOI: 10.1177/2374289518773493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/21/2018] [Indexed: 11/17/2022] Open
Abstract
Professionalism and physician well-being are important topics in academic medicine. Lapses in professional judgment may lead to disciplinary action and put patient's health at risk. Within medical education, students and trainees are exposed to professionalism in the institution's formal curriculum and hidden curriculum. Development of professionalism starts early in medical school. Trainees entering graduate medical education already have developed professional behavior. As a learned behavior, development of professional behavior is modifiable. In addition to role modeling by faculty, other modalities are needed. Use of case vignettes based on real-life issues encountered in trainee and faculty behavior can serve as a basis for continued development of professionalism in trainees. Based on the experience of program directors and pathology educators, case vignettes were developed in the domains of service, research, and education and subdivided into the areas of duty, integrity, and respect. General and specific questions pertaining to each case were generated to reinforce model behavior and overcome professionalism issues encountered in the hidden curriculum. To address physician burnout, cases were generated to provide trainees with the skills to deal with burnout and promote well-being.
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Affiliation(s)
- Richard M. Conran
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Ronald E. Domen
- Department of Pathology, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, USA
| | - Cindy B. McCloskey
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - David A. Cohen
- Emory University Hospital, Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - Lisa Ross Dixon
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Melissa Robin George
- Department of Pathology, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, USA
| | - Dita A. Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Miriam D. Post
- Department of Pathology, University of Colorado—Anschutz Medical Campus, Aurora, CO, USA
| | | | - Amyn M. Rojiani
- Department of Pathology, Augusta University-Medical College of Georgia, Augusta, GA, USA
| | | | | | - Robert D. Hoffman
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
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1356
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García-Giménez JL, Seco-Cervera M, Tollefsbol TO, Romá-Mateo C, Peiró-Chova L, Lapunzina P, Pallardó FV. Epigenetic biomarkers: Current strategies and future challenges for their use in the clinical laboratory. Crit Rev Clin Lab Sci 2017; 54:529-550. [PMID: 29226748 DOI: 10.1080/10408363.2017.1410520] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Epigenetic modifications and regulators represent potential molecular elements which control relevant physiological and pathological features, thereby contributing to the natural history of human disease. These epigenetic modulators can be employed as disease biomarkers, since they show several advantages and provide information about gene function, thus explaining differences among patient endophenotypes. In addition, epigenetic biomarkers can incorporate information regarding the effects of the environment and lifestyle on health and disease, and monitor the effect of applied therapies. Technologies used to analyze these epigenetic biomarkers are constantly improving, becoming much easier to use. Laboratory professionals can easily acquire experience and techniques are becoming more affordable. A high number of epigenetic biomarker candidates are being continuously proposed, making now the moment to adopt epigenetics in the clinical laboratory and convert epigenetic marks into reliable biomarkers. In this review, we describe some current promising epigenetic biomarkers and technologies being applied in clinical practice. Furthermore, we will discuss some laboratory strategies and kits to accelerate the adoption of epigenetic biomarkers into clinical routine. The likelihood is that over time, better markers will be identified and will likely be incorporated into future multi-target assays that might help to optimize its application in a clinical laboratory. This will improve cost-effectiveness, and consequently encourage the development of theragnosis and the application of precision medicine.
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Affiliation(s)
- José Luis García-Giménez
- a Center for Biomedical Network Research on Rare Diseases (CIBERER) , Institute of Health Carlos III , Valencia , Spain.,b INCLIVA Biomedical Research Institute , Valencia , Spain.,c Department Physiology, School of Medicine and Dentistry , Universitat de València (UV) , Valencia , Spain.,d Epigenetics Research Platform (CIBERER/UV/INCLIVA) , Valencia , Spain.,e EpiDisease S.L. Spin-Off of CIBERER (ISCIII) , Valencia , Spain
| | - Marta Seco-Cervera
- a Center for Biomedical Network Research on Rare Diseases (CIBERER) , Institute of Health Carlos III , Valencia , Spain.,b INCLIVA Biomedical Research Institute , Valencia , Spain.,c Department Physiology, School of Medicine and Dentistry , Universitat de València (UV) , Valencia , Spain
| | - Trygve O Tollefsbol
- f Department of Biology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Carlos Romá-Mateo
- a Center for Biomedical Network Research on Rare Diseases (CIBERER) , Institute of Health Carlos III , Valencia , Spain.,b INCLIVA Biomedical Research Institute , Valencia , Spain.,c Department Physiology, School of Medicine and Dentistry , Universitat de València (UV) , Valencia , Spain.,d Epigenetics Research Platform (CIBERER/UV/INCLIVA) , Valencia , Spain
| | - Lorena Peiró-Chova
- b INCLIVA Biomedical Research Institute , Valencia , Spain.,g INCLIVA Biobank , Valencia , Spain
| | - Pablo Lapunzina
- a Center for Biomedical Network Research on Rare Diseases (CIBERER) , Institute of Health Carlos III , Valencia , Spain.,h Institute of Medical and Molecular Genetics (INGEMM) , IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma de Madrid , Madrid , Spain
| | - Federico V Pallardó
- a Center for Biomedical Network Research on Rare Diseases (CIBERER) , Institute of Health Carlos III , Valencia , Spain.,b INCLIVA Biomedical Research Institute , Valencia , Spain.,c Department Physiology, School of Medicine and Dentistry , Universitat de València (UV) , Valencia , Spain.,d Epigenetics Research Platform (CIBERER/UV/INCLIVA) , Valencia , Spain
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1357
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Basehore PM, Mortensen LH, Katsaros E, Linsenmeyer M, McClain EK, Sexton PS, Wadsworth N. Entrustable Professional Activities for Entering Residency: Establishing Common Osteopathic Performance Standards in the Transition From Medical School to Residency. J Osteopath Med 2017; 117:712-718. [DOI: 10.7556/jaoa.2017.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Entrustable professional activities (EPAs) are measurable units of observable professional practice that can be entrusted to an unsupervised trainee. They were first introduced as a method of operationalizing competency-based medical education in graduate medical education. The American Association of Medical Colleges subsequently used EPAs to establish the core skills that medical students must be able to perform before they enter residency training. A recently published guide provides descriptions, guidelines, and rationale for implementing and assessing the core EPAs from an osteopathic approach. These osteopathically informed EPAs can allow schools to more appropriately assess a learner's whole-person approach to a patient, in alignment with the philosophy of the profession. As the single accreditation system for graduate medical education moves forward, it will be critical to integrate EPAs into osteopathic medical education to demonstrate entrustment of medical school graduates. The authors describe the collaborative process used to establish the osteopathic considerations added to EPAs and explores the challenges and opportunities for undergraduate osteopathic medical education.
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1358
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Wu RI. Assessing cytopathology milestones with checklists and online learning. Cancer Cytopathol 2017; 126:9-10. [DOI: 10.1002/cncy.21938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Roseann I. Wu
- Department of Pathology and Laboratory Medicine; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
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1359
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Shaikh U, Acosta DA, Freischlag JA, Young HM, Villablanca AC. Developing Diverse Leaders at Academic Health Centers: A Prerequisite to Quality Health Care? Am J Med Qual 2017; 33:440-442. [PMID: 29027473 DOI: 10.1177/1062860617733545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - David A Acosta
- 2 American Association of Medical Colleges, Washington, DC
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1360
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Bailey DN, Lipscomb MF, Gorstein F, Wilkinson D, Sanfilippo F. Life After Being a Pathology Department Chair II: Lessons Learned. Acad Pathol 2017; 4:2374289517733734. [PMID: 29057316 PMCID: PMC5642005 DOI: 10.1177/2374289517733734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 11/16/2022] Open
Abstract
The 2016 Association of Pathology Chairs annual meeting featured a discussion group of Association of Pathology Chairs senior fellows (former chairs of academic departments of pathology who have remained active in Association of Pathology Chairs) that focused on how they decided to transition from the chair, how they prepared for such transition, and what they did after the transition. At the 2017 annual meeting, the senior fellows (encompassing 481 years of chair service) discussed lessons they learned from service as chair. These lessons included preparation for the chairship, what they would have done differently as chair, critical factors for success as chair, factors associated with failures, stress reduction techniques for themselves and for their faculty and staff, mechanisms for dealing with and avoiding problems, and the satisfaction they derived from their service as chair. It is reasonable to assume that these lessons may be representative of those learned by chairs of other specialties as well as by higher-level academic administrators such as deans, vice presidents, and chief executive officers. Although the environment for serving as a department chair has been changing dramatically, many of the lessons learned by former chairs are still valuable for current chairs of any length of tenure.
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Affiliation(s)
- David N Bailey
- Department of Pathology University of California, San Diego, La Jolla, CA, USA
| | - Mary F Lipscomb
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Fred Gorstein
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Wilkinson
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
| | - Fred Sanfilippo
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
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1361
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Brissette MD, Johnson KA, Raciti PM, McCloskey CB, Gratzinger DA, Conran RM, Domen RE, Hoffman RD, Post MD, Roberts CA, Rojiani AM, Powell SZE. Perceptions of Unprofessional Attitudes and Behaviors: Implications for Faculty Role Modeling and Teaching Professionalism During Pathology Residency. Arch Pathol Lab Med 2017; 141:1394-1401. [PMID: 28686498 DOI: 10.5858/arpa.2016-0477-cp] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Changes occurring in medicine have raised issues about medical professionalism. Professionalism is included in the Core Competencies and Milestones for all pathology residents. Previous studies have looked at resident professionalism attitudes and behaviors in primary care but none have looked specifically at pathology. OBJECTIVE - To examine behavior and attitudes toward professionalism within pathology and to determine how professionalism is taught in residency programs. DESIGN - Surveys were sent to all College of American Pathologists junior members and all pathology residency program directors, and responses were compared. RESULTS - Although no single behavior received the same professionalism rating among residents and program directors, both groups identified the same behaviors as being the most unprofessional: posting identifiable patient information or case images to social media, making a disparaging comment about a physician colleague or member of the support staff on social media or in a public hospital space, and missing work without reporting the time off. Faculty were observed displaying most of these behaviors as often or more often than residents by both groups. The most common means to teach professionalism in pathology residencies is providing feedback as situations arise and teaching by example. Age differences were found within each group and between groups for observed behaviors and attitudes. CONCLUSIONS - As teaching by example was identified as a common educational method, faculty must be aware of the role their behavior and attitudes have in shaping resident behavior and attitudes. These results suggest a need for additional resources to teach professionalism during pathology residency.
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1362
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Clay MR, Fisher KE. Bioinformatics Education in Pathology Training: Current Scope and Future Direction. Cancer Inform 2017; 16:1176935117703389. [PMID: 28469393 PMCID: PMC5392012 DOI: 10.1177/1176935117703389] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/20/2017] [Indexed: 12/11/2022] Open
Abstract
Training anatomic and clinical pathology residents in the principles of bioinformatics is a challenging endeavor. Most residents receive little to no formal exposure to bioinformatics during medical education, and most of the pathology training is spent interpreting histopathology slides using light microscopy or focused on laboratory regulation, management, and interpretation of discrete laboratory data. At a minimum, residents should be familiar with data structure, data pipelines, data manipulation, and data regulations within clinical laboratories. Fellowship-level training should incorporate advanced principles unique to each subspecialty. Barriers to bioinformatics education include the clinical apprenticeship training model, ill-defined educational milestones, inadequate faculty expertise, and limited exposure during medical training. Online educational resources, case-based learning, and incorporation into molecular genomics education could serve as effective educational strategies. Overall, pathology bioinformatics training can be incorporated into pathology resident curricula, provided there is motivation to incorporate, institutional support, educational resources, and adequate faculty expertise.
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Affiliation(s)
- Michael R Clay
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin E Fisher
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.,Department of Pathology, Texas Children's Hospital, Houston, TX, USA
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1363
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Davey DD. Bridging the Gap: Training and Education in the Pathology and Cytopathology Sphere. Cancer Cytopathol 2017; 125:371-372. [PMID: 28319328 DOI: 10.1002/cncy.21845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Diane Davis Davey
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, Florida
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1364
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Brooks EG, Thornton JM, Ranheim EA, Fabry Z. Incorporation of autopsy case-based learning into PhD graduate education: a novel approach to bridging the "bench-to-bedside" gap. Hum Pathol 2017; 68:1-6. [PMID: 28315694 DOI: 10.1016/j.humpath.2017.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 02/12/2017] [Accepted: 03/02/2017] [Indexed: 11/28/2022]
Abstract
Given the current rapid expansion of biological knowledge and the challenges of translating that knowledge into clinical practice, finding effective methods of teaching graduate students clinical medicine concepts has become even more critical. The utility of autopsy in medical student and resident education has been well established. Multiple studies have reported it to be a helpful means of teaching anatomy, pathophysiology, clinical problem-solving skills, and medical diagnostic techniques. Although various models of training PhD candidates in clinical medicine have been reported, an autopsy-based curriculum has not been previously described. For over 4 years, our pathology department has offered a novel semester-long autopsy-based course to educate future Cellular and Molecular Pathology scientists about clinical medicine. Our results indicate that this "hands-on" approach is a popular as well as effective means of teaching the pathogenesis of disease at the level of the cell, organ, and patient. The course reputation has recently led to requests to open registration to graduate students from other university programs as well as undergraduate students. Additionally, it has played an important role in our Cellular and Molecular Pathology program's recent receipt of a 5-year renewal National Institutes of Health-funded T32 award. Overall, this course model has been successful at our own institution and could provide a useful template for other institutions seeking to provide graduate investigators with in-depth exposure to clinical medicine.
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Affiliation(s)
- Erin G Brooks
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, 53792.
| | - Joanne M Thornton
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, 53792
| | - Erik A Ranheim
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, 53792
| | - Zsuzsanna Fabry
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, 53792
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1365
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Robboy SJ, McLendon R. Structured Annual Faculty Review Program Accelerates Professional Development and Promotion: Long-Term Experience of the Duke University Medical Center's Pathology Department. Acad Pathol 2017; 4:2374289516689471. [PMID: 28725786 PMCID: PMC5497916 DOI: 10.1177/2374289516689471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/10/2016] [Accepted: 12/17/2016] [Indexed: 11/15/2022] Open
Abstract
This retrospective observational study on faculty development analyzes the Duke University Pathology Department's 18-year experience with a structured mentoring program involving 51 junior faculty members. The majority had MD degrees only (55%). The percentage of young women faculty hires before 1998 was 25%, increasing to 72% after 2005. Diversity also broadened from 9% with varied heritages before 1998 to 37% since then. The mentoring process pivoted on an annual review process. The reviews generally helped candidates focus much earlier, identified impediments they individually felt, and provided new avenues to gain a national reputation for academic excellence. National committee membership effectively helped gain national exposure. Thirty-eight percent of the mentees served on College of American Pathologists (CAP) committees, exponential multiples of any other national society. Some used CAP resources to develop major programs, some becoming nationally and internationally recognized for their academic activities. Several faculty gained national recognition as thought leaders for publishing about work initiated to serve administrative needs in the Department. The review process identified the need for more protected time for research, issues with time constraints, and avoiding exploitation when collaborating with other departments. This review identified a rigorous faculty mentoring and review process that included annual career counseling, goal-oriented academic careers, monitored advancement to promotion, higher salaries, and national recognition. All contributed to high faculty satisfaction and low faculty turnover. We conclude that a rigorous annual faculty review program and its natural sequence, promotion, can greatly foster faculty satisfaction.
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Affiliation(s)
- Stanley J Robboy
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Roger McLendon
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
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1366
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Krasowski MD, Ford BA, Klutts JS, Jensen CS, Briggs AS, Robinson RA, Bruch LA, Karandikar NJ. Using Focused Laboratory Management and Quality Improvement Projects to Enhance Resident Training and Foster Scholarship. Acad Pathol 2017; 4:2374289517722152. [PMID: 28913416 PMCID: PMC5590695 DOI: 10.1177/2374289517722152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 11/22/2022] Open
Abstract
Training in patient safety, quality, and management is widely recognized as an important element of graduate medical education. These concepts have been intertwined in pathology graduate medical education for many years, although training programs face challenges in creating explicit learning opportunities in these fields. Tangibly involving pathology residents in management and quality improvement projects has the potential to teach and reinforce key concepts and further fulfill Accreditation Council for Graduate Medical Education goals for pursuing projects related to patient safety and quality improvement. In this report, we present our experience at a pathology residency program (University of Iowa) in engaging pathology residents in projects related to practical issues of laboratory management, process improvement, and informatics. In this program, at least 1 management/quality improvement project, typically performed during a clinical chemistry/management rotation, was required and ideally resulted in a journal publication. The residency program also initiated a monthly management/informatics series for pathology externs, residents, and fellows that covers a wide range of topics. Since 2010, all pathology residents at the University of Iowa have completed at least 1 management/quality improvement project. Many of the projects involved aspects of laboratory test utilization, with some projects focused on other areas such as human resources, informatics, or process improvement. Since 2012, 31 peer-reviewed journal articles involving effort from 26 residents have been published. Multiple projects resulted in changes in ongoing practice, particularly within the hospital electronic health record. Focused management/quality improvement projects involving pathology residents can result in both meaningful quality improvement and scholarly output.
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Affiliation(s)
- Matthew D. Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Bradley A. Ford
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - J. Stacey Klutts
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Pathology and Laboratory Medicine, Iowa City VA Health Care System, Iowa City, IA, USA
| | - Chris S. Jensen
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Angela S. Briggs
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Robert A. Robinson
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Leslie A. Bruch
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nitin J. Karandikar
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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1367
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Naugler C, Hemmelgarn B, Quan H, Clement F, Sajobi T, Thomas R, Turin TC, Hnydyk W, Chin A, Wesenberg J. Implementation of an intervention to reduce population-based screening for vitamin D deficiency: a cross-sectional study. CMAJ Open 2017; 5:E36-E39. [PMID: 28401116 PMCID: PMC5378529 DOI: 10.9778/cmajo.20160073] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND We describe the implementation of an intervention in Alberta in support of the Choosing Wisely Canada recommendation against population screening for vitamin D deficiency (as determined by serum total 25-hydroxyvitamin D testing). We hypothesized that the introduction of a specialized requisition for vitamin D testing would reduce the annual number of vitamin D tests performed. METHODS We performed a cross-sectional observational study that included all vitamin D tests ordered in Alberta between Apr. 1, 2015, and Mar. 31, 2016. There were no exclusion criteria. A special requisition for ordering vitamin D tests in Alberta was introduced on Apr. 1, 2015. Using an interrupted time series model, we compared predicted versus observed vitamin D test volumes for the 12-month period following the introduction of the new requisition. The sole outcome measure was the monthly change in volume of vitamin D testing. In addition, we calculated any cost savings as a result of reduced testing. RESULTS Over the first 12 months of the intervention, there was a reduction in the number of tests ordered from a predicted 342 477 tests to 29 525 tests (91.4% reduction). This decrease represented a direct spending decrease of Can$938 856-$1 564 760 per year in Alberta. INTERPRETATION A provincially led implementation of a Choosing Wisely Canada recommendation resulted in a large and sustained reduction in serum total 25-hydroxyvitamin D testing in Alberta. This study shows that provincially led interventions based on Choosing Wisely Canada recommendations can result in substantial reductions in laboratory tests.
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Affiliation(s)
- Christopher Naugler
- Departments of Pathology and Laboratory Medicine (Naugler, Chin), Family Medicine (Naugler, Thomas, Turin), Community Health Sciences (Hemmelgarn, Quan, Clement, Sajobi), Cumming School of Medicine, University of Calgary, Calgary, Alta; Alberta Medical Association (Hnydyk), Edmonton, Alta; Red Deer Regional Hospital Centre (Wesenberg), Clinical Laboratory, Red Deer, Alta
| | - Brenda Hemmelgarn
- Departments of Pathology and Laboratory Medicine (Naugler, Chin), Family Medicine (Naugler, Thomas, Turin), Community Health Sciences (Hemmelgarn, Quan, Clement, Sajobi), Cumming School of Medicine, University of Calgary, Calgary, Alta; Alberta Medical Association (Hnydyk), Edmonton, Alta; Red Deer Regional Hospital Centre (Wesenberg), Clinical Laboratory, Red Deer, Alta
| | - Hude Quan
- Departments of Pathology and Laboratory Medicine (Naugler, Chin), Family Medicine (Naugler, Thomas, Turin), Community Health Sciences (Hemmelgarn, Quan, Clement, Sajobi), Cumming School of Medicine, University of Calgary, Calgary, Alta; Alberta Medical Association (Hnydyk), Edmonton, Alta; Red Deer Regional Hospital Centre (Wesenberg), Clinical Laboratory, Red Deer, Alta
| | - Fiona Clement
- Departments of Pathology and Laboratory Medicine (Naugler, Chin), Family Medicine (Naugler, Thomas, Turin), Community Health Sciences (Hemmelgarn, Quan, Clement, Sajobi), Cumming School of Medicine, University of Calgary, Calgary, Alta; Alberta Medical Association (Hnydyk), Edmonton, Alta; Red Deer Regional Hospital Centre (Wesenberg), Clinical Laboratory, Red Deer, Alta
| | - Tolulope Sajobi
- Departments of Pathology and Laboratory Medicine (Naugler, Chin), Family Medicine (Naugler, Thomas, Turin), Community Health Sciences (Hemmelgarn, Quan, Clement, Sajobi), Cumming School of Medicine, University of Calgary, Calgary, Alta; Alberta Medical Association (Hnydyk), Edmonton, Alta; Red Deer Regional Hospital Centre (Wesenberg), Clinical Laboratory, Red Deer, Alta
| | - Roger Thomas
- Departments of Pathology and Laboratory Medicine (Naugler, Chin), Family Medicine (Naugler, Thomas, Turin), Community Health Sciences (Hemmelgarn, Quan, Clement, Sajobi), Cumming School of Medicine, University of Calgary, Calgary, Alta; Alberta Medical Association (Hnydyk), Edmonton, Alta; Red Deer Regional Hospital Centre (Wesenberg), Clinical Laboratory, Red Deer, Alta
| | - Tanvir C Turin
- Departments of Pathology and Laboratory Medicine (Naugler, Chin), Family Medicine (Naugler, Thomas, Turin), Community Health Sciences (Hemmelgarn, Quan, Clement, Sajobi), Cumming School of Medicine, University of Calgary, Calgary, Alta; Alberta Medical Association (Hnydyk), Edmonton, Alta; Red Deer Regional Hospital Centre (Wesenberg), Clinical Laboratory, Red Deer, Alta
| | - William Hnydyk
- Departments of Pathology and Laboratory Medicine (Naugler, Chin), Family Medicine (Naugler, Thomas, Turin), Community Health Sciences (Hemmelgarn, Quan, Clement, Sajobi), Cumming School of Medicine, University of Calgary, Calgary, Alta; Alberta Medical Association (Hnydyk), Edmonton, Alta; Red Deer Regional Hospital Centre (Wesenberg), Clinical Laboratory, Red Deer, Alta
| | - Alex Chin
- Departments of Pathology and Laboratory Medicine (Naugler, Chin), Family Medicine (Naugler, Thomas, Turin), Community Health Sciences (Hemmelgarn, Quan, Clement, Sajobi), Cumming School of Medicine, University of Calgary, Calgary, Alta; Alberta Medical Association (Hnydyk), Edmonton, Alta; Red Deer Regional Hospital Centre (Wesenberg), Clinical Laboratory, Red Deer, Alta
| | - James Wesenberg
- Departments of Pathology and Laboratory Medicine (Naugler, Chin), Family Medicine (Naugler, Thomas, Turin), Community Health Sciences (Hemmelgarn, Quan, Clement, Sajobi), Cumming School of Medicine, University of Calgary, Calgary, Alta; Alberta Medical Association (Hnydyk), Edmonton, Alta; Red Deer Regional Hospital Centre (Wesenberg), Clinical Laboratory, Red Deer, Alta
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1368
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Rae G, Cork JR, Karpinski AC, McGoey R, Swartz W. How the Integration of Pathology in the Gross Anatomy Laboratory Affects Medical Students. TEACHING AND LEARNING IN MEDICINE 2017; 29:101-108. [PMID: 27314837 DOI: 10.1080/10401334.2016.1194761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PROBLEM The main objective of this project was to integrate pathologists into the gross anatomy laboratory setting to increase the exposure that early medical students receive to pathologists as clinicians. INTERVENTION Pathologists visited the gross anatomy laboratory 3 times throughout the 15-week course to assist medical students in determining the cause of death of the cadaver being dissected. CONTEXT This intervention was implemented with 1st-semester medical students for 2 consecutive years (a total of 100 dissection teams consisting of 4 students in each team). OUTCOME A quantitative content analysis was performed on the students' end of the course assignments to determine whether the students learned a greater percentage of pathologic information by having interactions with pathologists in the gross lab and to identify trends in the way medical students diagnosed their "first patient" (i.e., the cadaver). The students who had interactions with pathologists in the laboratory had significantly more pathology in their narrative than the students who did not receive pathologist interaction. They were also more likely to conclude that the cadaver they dissected actually died from a cause other than the one listed on the death certificate (18.3%; n = 15) compared to the students who had no pathologist interaction (1.8%; n = 2). A postintervention survey indicated that 65% of students felt that interaction with pathologists helped them understand the clinical application of gross anatomy, more than 40% become more interested in pathology, and 74% would have liked to have had more pathologist interaction. LESSONS LEARNED This intervention demonstrated a way to increase pathologist interaction within the undergraduate medical curriculum and enhance the educational environment of the gross anatomy laboratory.
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Affiliation(s)
- Guenevere Rae
- a Department of Cell Biology and Anatomy , Louisiana State University Health Sciences Center , New Orleans , Louisiana , USA
| | - John R Cork
- a Department of Cell Biology and Anatomy , Louisiana State University Health Sciences Center , New Orleans , Louisiana , USA
| | - Aryn C Karpinski
- b Evaluation and Measurement, Kent State University , Kent , Ohio , USA
| | - Robin McGoey
- c Department of Pathology , Louisiana State University Health Sciences Center , New Orleans , Louisiana , USA
| | - William Swartz
- a Department of Cell Biology and Anatomy , Louisiana State University Health Sciences Center , New Orleans , Louisiana , USA
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1369
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Weinstein RS, Waer AL, Weinstein JB, Briehl MM, Holcomb MJ, Erps KA, Holtrust AL, Tomkins JM, Barker GP, Krupinski EA. Second Flexner Century: The Democratization of Medical Knowledge: Repurposing a General Pathology Course Into Multigrade-Level "Gateway" Courses. Acad Pathol 2017; 4:2374289517718872. [PMID: 28782004 PMCID: PMC5521343 DOI: 10.1177/2374289517718872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/09/2017] [Accepted: 06/10/2017] [Indexed: 11/23/2022] Open
Abstract
Starting in 1910, the "Flexner Revolution" in medical education catalyzed the transformation of the US medical education enterprise from a proprietary medical school dominated system into a university-based medical school system. In the 21st century, what we refer to as the "Second Flexner Century" shifts focus from the education of medical students to the education of the general population in the "4 health literacies." Compared with the remarkable success of the first Flexner Revolution, retrofitting medical science education into the US general population today, starting with K-12 students, is a more daunting task. The stakes are high. The emergence of the patient-centered medical home as a health-care delivery model and the revelation that medical errors are the third leading cause of adult deaths in the United States are drivers of population education reform. In this century, patients will be expected to assume far greater responsibility for their own health care as full members of health-care teams. For us, this process began in the run-up to the "Second Flexner Century" with the creation and testing of a general pathology course, repurposed as a series of "gateway" courses on mechanisms of diseases, suitable for introduction at multiple insertion points in the US education continuum. In this article, we describe nomenclature for these gateway courses and a "top-down" strategy for creating pathology coursework for nonmedical students. Finally, we list opportunities for academic pathology departments to engage in a national "Democratization of Medical Knowledge" initiative.
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Affiliation(s)
- Ronald S Weinstein
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA
- Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA
- Institute for Advanced Telemedicine and Telehealth (T-Health Institute), The University of Arizona, Phoenix, AZ, USA
| | - Amy L Waer
- Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA
- Department of Surgery, The University of Arizona, Tucson, AZ, USA
| | - John B Weinstein
- Bard Early Colleges, Bard College, Annandale-on-Hudson, Hamlet, New York, NY, USA
| | - Margaret M Briehl
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Michael J Holcomb
- Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA
- Institute for Advanced Telemedicine and Telehealth (T-Health Institute), The University of Arizona, Phoenix, AZ, USA
| | - Kristine A Erps
- Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA
- Institute for Advanced Telemedicine and Telehealth (T-Health Institute), The University of Arizona, Phoenix, AZ, USA
| | - Angelette L Holtrust
- Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA
- Institute for Advanced Telemedicine and Telehealth (T-Health Institute), The University of Arizona, Phoenix, AZ, USA
| | - Julie M Tomkins
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Gail P Barker
- Institute for Advanced Telemedicine and Telehealth (T-Health Institute), The University of Arizona, Phoenix, AZ, USA
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Elizabeth A Krupinski
- Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, GA, USA
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1370
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Hanley T, Sowder AM, Palmer CA, Weiss RL. Teaching Laboratory Management Principles and Practices Through Mentorship and Graduated Responsibility: The Assistant Medical Directorship. Acad Pathol 2016; 3:2374289516678972. [PMID: 28725781 PMCID: PMC5497864 DOI: 10.1177/2374289516678972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/14/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022] Open
Abstract
With the changing landscape of medicine in general, and pathology in particular, a greater emphasis is being placed on laboratory management as a means of controlling spiraling medical costs and improving health-care efficiency. To meet this challenge, pathology residency programs have begun to incorporate formal laboratory management training into their curricula, using institutional curricula and/or online laboratory management courses offered by professional organizations. At the University of Utah, and its affiliated national reference laboratory, ARUP Laboratories, Inc, interested residents are able to supplement the departmental lecture-based and online laboratory management curriculum by participating in assistant medical directorship programs in one of several pathology subspecialty disciplines. The goals of many of the assistant medical directorship positions include the development of laboratory management skills and competencies. A survey of current and recent assistant medical directorship participants revealed that the assistant medical directorship program serves as an excellent means of improving laboratory management skills, as well as improving performance as a fellow and practicing pathologist.
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Affiliation(s)
- Timothy Hanley
- Department of Pathology, School of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Aleksandra M Sowder
- Department of Pathology, School of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Cheryl Ann Palmer
- Department of Pathology, School of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,ARUP Laboratories, University of Utah, Salt Lake City, UT, USA
| | - Ronald L Weiss
- Department of Pathology, School of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,ARUP Laboratories, University of Utah, Salt Lake City, UT, USA
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1371
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Naritoku WY, Powell SZ, Black-Schaffer WS. Evolution of the Pathology Residency Curriculum: Preparing for a Positive Future. Acad Pathol 2016; 3:2374289516667746. [PMID: 28725779 PMCID: PMC5497861 DOI: 10.1177/2374289516667746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/12/2016] [Accepted: 08/13/2016] [Indexed: 11/19/2022] Open
Abstract
The required medical knowledge and skill set for the pathologist of 2020 are different than in 2005. Pathology residency training curriculum must accordingly change to fulfill the needs of these ever-changing requirements. In order to make rational curricular adjustments, it is important for us to know the current trajectory of resident training in pathology—where we have been, what our actual current training curriculum is now—to understand how that might change in anticipation of meeting the needs of a changing patient and provider population and to fit within the evolving future biomedical and socioeconomic health-care setting. In 2013, there were 143 Accreditation Council for Graduate Medical Education-accredited pathology residency training programs in the United States, with approximately 2400 residents. There is diversity among residency training programs not only with respect to the number of residents but also in training venue(s). To characterize this diversity among pathology residency training programs, a curriculum survey was conducted of pathology residency program directors in 2013 and compared with a similar survey taken almost 9 years previously in 2005 to identify trends in pathology residency curriculum. Clinical pathology has not changed significantly in the number of rotations over 9 years; however, anatomic pathology has changed dramatically, with an increase in the number of surgical pathology rotations coupled with a decline in stand-alone autopsy rotations. With ever-expanding medical knowledge that the graduating pathology resident must know, it is necessary to (1) reflect upon what are the critical need subjects, (2) identify areas that have become of lesser importance, and then (3) prioritize training accordingly.
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Affiliation(s)
- Wesley Y Naritoku
- Department of Pathology and Laboratory Medicine, USC/LAC+USC Medical Center, Los Angeles, CA, USA
| | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Fannin, Houston, TX, USA
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1372
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Black-Schaffer WS, Morrow JS, Prystowsky MB, Steinberg JJ. Training Pathology Residents to Practice 21st Century Medicine: A Proposal. Acad Pathol 2016; 3:2374289516665393. [PMID: 28725776 PMCID: PMC5497917 DOI: 10.1177/2374289516665393] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/28/2016] [Accepted: 07/31/2016] [Indexed: 01/17/2023] Open
Abstract
Scientific advances, open information access, and evolving health-care economics are disrupting extant models of health-care delivery. Physicians increasingly practice as team members, accountable to payers and patients, with improved efficiency, value, and quality. This change along with a greater focus on population health affects how systems of care are structured and delivered. Pathologists are not immune to these disruptors and, in fact, may be one of the most affected medical specialties. In the coming decades, it is likely that the number of practicing pathologists will decline, requiring each pathologist to serve more and often sicker patients. The demand for increasingly sophisticated yet broader diagnostic skills will continue to grow. This will require pathologists to acquire appropriate professional training and interpersonal skills. Today’s pathology training programs are ill designed to prepare such practitioners. The time to practice for most pathology trainees is typically 5 to 6 years. Yet, trainees often lack sufficient experience to practice independently and effectively. Many studies have recognized these challenges suggesting that more effective training for this new century can be implemented. Building on the strengths of existing programs, we propose a redesign of pathology residency training that will meet (and encourage) a continuing evolution of American Board of Pathology and Accreditation Council for Graduate Medical Education requirements, reduce the time to readiness for practice, and produce more effective, interactive, and adaptable pathologists. The essence of this new model is clear definition and acquisition of core knowledge and practice skills that span the anatomic and clinical pathology continuum during the first 2 years, assessed by competency-based metrics with emphasis on critical thinking and skill acquisition, followed by individualized modular training with intensively progressive responsibility during the final years of training. We anticipate that implementing some or all aspects of this model will enable residents to attain a higher level of competency within the current time-based constraints of residency training.
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Affiliation(s)
- W Stephen Black-Schaffer
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jon S Morrow
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Michael B Prystowsky
- Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Jacob J Steinberg
- Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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1373
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Gronowski AM, McGill MR, Domen RE. Professionalism in Residency Training: A Compilation of Desirable Behaviors and a Case-Based Comparison Between Pathologists in Training and Practice. Acad Pathol 2016; 3:2374289516667509. [PMID: 28725778 PMCID: PMC5497910 DOI: 10.1177/2374289516667509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/22/2022] Open
Abstract
Professionalism is one of the most important competencies for physicians but is also the most difficult to teach, assess, and manage. To better understand professionalism in pathology, we surveyed practicing pathologists and pathology residents and fellows in training. We identified 12 key desirable attributes of professionalism. In addition, 8 case scenarios highlighting unprofessional behavior were presented, and results between pathologists in practice and in training were compared. No significant differences between attending pathologists and residents were identified in how these cases should be managed. Our study demonstrated remarkable concordance between practicing pathologists and residents as to what constitutes professionalism and how to manage unprofessional behavior. Our case-based approach can be a useful technique to teach professionalism to both pathologists in practice and in training.
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Affiliation(s)
- Ann M Gronowski
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Mitchell R McGill
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Ronald E Domen
- Department of Pathology, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, USA
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1374
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Bracamonte E, Gibson BA, Klein R, Krupinski EA, Weinstein RS. Communicating Uncertainty in Surgical Pathology Reports: A Survey of Staff Physicians and Residents at an Academic Medical Center. Acad Pathol 2016; 3:2374289516659079. [PMID: 28725774 PMCID: PMC5497900 DOI: 10.1177/2374289516659079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 11/17/2022] Open
Abstract
In order to document perceptions of text comments appearing in surgical pathology reports, questionnaires were distributed to 4 groups of caregivers: university staff pathologists, resident pathologists, faculty clinicians (other than pathologists), and resident clinicians at a teaching hospital. Results of this pilot study showed a wide degree of variability existed within each group of surgical pathology report users, with respect to percent confidence assigned to various phrases, commonly used to express diagnostic uncertainty, appearing often as free-text comments in surgical pathology reports. The unavailability of immunohistochemistry tests, or ambiguous immunohistochemistry test results, was especially problematic. With respect to modes of communication between the surgical pathology laboratory and its service users, clinicians indicated they preferred to use tumor boards/interdisciplinary conferences, face-to-face meetings, and phone calls to clarify their interpretations of a pathologist’s diagnoses, as compared with simply reading free-text comments. On the other hand, surgical pathologists rely heavily on their use of the comment portion of a surgical pathology report to clarify, modify, or expand on the diagnoses they render. The majority of clinicians stated that they “always” read the free-text comment portion of a surgical pathology report, whereas some acknowledged they do not always read it. Pathology residents had significantly less confidence in the ability of a free-text comment on a surgical pathology report to clarify a diagnosis (χ2 = 46.36, P < .0001). Pathology departments should consider standardizing definitions and weighting the words and phrases they use in their free-text comment sections of surgical pathology reports.
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Affiliation(s)
- Erika Bracamonte
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Blake A Gibson
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Robert Klein
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Ronald S Weinstein
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
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1375
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Remick DG, Lorenz RG, Smith BR. Opportunity: Newly Created Physician-Scientist Research Pathway by the American Board of Pathology. Acad Pathol 2016; 3:2374289516632240. [PMID: 28725759 PMCID: PMC5497862 DOI: 10.1177/2374289516632240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Robin G. Lorenz
- Departments of Pathology and Medical Education, University of Alabama at Birmingham, Birmingham, AL, USA
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1376
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Briehl MM, Nelson MA, Krupinski EA, Erps KA, Holcomb MJ, Weinstein JB, Weinstein RS. Flexner 2.0-Longitudinal Study of Student Participation in a Campus-Wide General Pathology Course for Graduate Students at The University of Arizona. Acad Pathol 2016; 3:2374289516680217. [PMID: 28725783 PMCID: PMC5497920 DOI: 10.1177/2374289516680217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 11/15/2022] Open
Abstract
Faculty members from the Department of Pathology at The University of Arizona College of Medicine-Tucson have offered a 4-credit course on enhanced general pathology for graduate students since 1996. The course is titled, "Mechanisms of Human Disease." Between 1997 and 2016, 270 graduate students completed Mechanisms of Human Disease. The students came from 21 programs of study. Analysis of Variance, using course grade as the dependent and degree, program, gender, and year (1997-2016) as independent variables, indicated that there was no significant difference in final grade (F = 0.112; P = .8856) as a function of degree (doctorate: mean = 89.60, standard deviation = 5.75; master's: mean = 89.34, standard deviation = 6.00; certificate program: mean = 88.64, standard deviation = 8.25), specific type of degree program (F = 2.066, P = .1316; life sciences: mean = 89.95, standard deviation = 6.40; pharmaceutical sciences: mean = 90.71, standard deviation = 4.57; physical sciences: mean = 87.79, standard deviation = 5.17), or as a function of gender (F = 2.96, P = .0865; males: mean = 88.09, standard deviation = 8.36; females: mean = 89.58, standard deviation = 5.82). Students in the physical and life sciences performed equally well. Mechanisms of Human Disease is a popular course that provides students enrolled in a variety of graduate programs with a medical school-based course on mechanisms of diseases. The addition of 2 new medically oriented Master of Science degree programs has nearly tripled enrollment. This graduate level course also potentially expands the interdisciplinary diversity of participants in our interprofessional education and collaborative practice exercises.
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Affiliation(s)
- Margaret M. Briehl
- Department of Pathology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mark A. Nelson
- Department of Pathology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Kristine A. Erps
- Department of Pathology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Michael J. Holcomb
- Department of Pathology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Ronald S. Weinstein
- Department of Pathology, College of Medicine, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Department of Public Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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